Provider Demographics
NPI:1801257183
Name:FUNES, SOFIA ABIGAIL (DO)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:ABIGAIL
Last Name:FUNES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5961 N FALLS CIRCLE DR APT 401
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-6818
Mailing Address - Country:US
Mailing Address - Phone:352-615-2950
Mailing Address - Fax:
Practice Address - Street 1:5961 N FALLS CIRCLE DR APT 401
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-6818
Practice Address - Country:US
Practice Address - Phone:352-615-2950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-14
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS15427204C00000X, 204D00000X, 2083P0901X, 2083S0010X
390200000X
FL154272083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program